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Home My WebLink About2728 CAZADERO DR; ; CBR2021-1746; PermitPrint Date: 11/15/2022 Permit No: CBR2021-1746 Building Permit Finaled Residential Permit Job Address: Permit Type: Parcel #: Valuation: Occupancy Group: 2728 CAZADERO DR, CARLSBAD, CA 92009-5813 BLDG-Residential 2154000500 $29,600.35 Work Class: Lot #: Project #: Pool Status: Applied: Issued: 06/16/2021 09/22/2021 Finaled Close Out:11/15/2022 #of Dwelling Units: Track #: Plan #: Closed - Finaled Plan Check #: Orig. Plan Check #:Bathrooms: Final Inspection:01/21/2022Bedrooms:Construction Type: Occupant Load: Code Edition: Sprinkled: INSPECTOR:Alvarado, Tony SCOTT: NEW POOL & SPA (565 SF) (E-REVIEW)Description: Project Title: Applicant: SWIFT PERMITS MATT PARTRIDGE 6469 PANEL CT SAN DIEGO, CA 92122-3007(209) 595-9788 Property Owner: CO-OWNERS MATTHEW AND YASMINE SCOTT 2728 CAZADERO DR CARLSBAD, CA 92009 CoApplicant: CUSTOM CREATIONS WEST INC 1151 S SANTA FE AVE VISTA, CA 92083-7228 (760) 248-3297 AMOUNTFEE BUILDING PERMIT FEE ($2000+)$278.00 BUILDING PLAN CHECK FEE (BLDG)$194.60 ELECTRICAL BLDG RESIDENTIAL NEW/ADDITION/REMODEL $41.00 PLUMBING BLDG RESIDENTIAL NEW/ADDITION/REMODEL $62.00 SB1473 – GREEN BUILDING STATE STANDARDS FEE $2.00 STRONG MOTION – RESIDENTIAL (SMIP)$3.85 SWPPP INSPECTION FEE TIER 1 - Medium BLDG $246.00 SWPPP PLAN REVIEW FEE TIER 1 - Medium $55.00 Total Fees:$882.45 Total Payments To Date:$882.45 Balance Due:$0.00 Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. 1635 Faraday Avenue, Carlsbad CA 92008-7314 ï 442-339-2719 ï 760-602-8560 f ï www.carlsbadca.gov Building Division Page 1 of 1 {"Cityof Carlsbad Plan Check Est. Value PC Deposit Date B-1 Page 1 of 2 Rev. 06/18 RESIDENTIAL BUILDI NG PERMIT APPLICATION B-1 Job Address __________________________________________Suite: __________ APN: _________________________ CT/Project #:_________________________________________ Lot #:_________ Fire Sprinklers: YES NO Air Conditioning: YES NO Electrical Panel Upgrade: YES NO BRIEF DESCRIPTION OF WORK: ________________________________________________________________________ __________________________________________________________________________________________________ APPLICANT (PRIMARY CONTACT) PROPERTY OWNER Name: ________________________________________ Name: _____________________________________________ Address: ______________________________________ Address: ____________________________________________ City: _________________ State:______Zip: _________ City: ______________________State:______Zip: ___________ Phone: _______________________________________ Phone: _____________________________________________ Email: ________________________________________ Email: ______________________________________________ DESIGN PROFESSIONAL CONTRACTOR BUSINESS Name: ________________________________________ Name: _____________________________________________ Address: ______________________________________ Address: ___________________________________________ City: _________________ State:______Zip: __________ City: _________________ State:______Zip: _______________ Phone: _______________________________________ Phone: ____________________________________________ Email: ________________________________________ Email: _____________________________________________ Architect State License: __________________________ State License:_____________ Bus. License:_______________ (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor’s License Law {Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or that he/she is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500}). 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov Addition/New: ____________Living SF, ________ Deck SF, ________ Patio SF, ________Garage SF Is this to create an Accessory Dwelling Unit? Y N New Fireplace? Y N , if yes how many? _____ Remodel: __________ SF of affected area Is the area a conversion or change of use ? Y N Pool/Spa: __________ SF Additional Gas or Electrical Features? _____________________________ Solar: _______ KW, ______ Modules, Mounted: Roof Ground , Tilt: Y N, RMA: Y N, Battery: Y N, Panel Upgrade: Y N Reroof: ____________________________________________________________________________________ Plumbing/Mechanical/Electrical Only: ___________________________________________________________ Other: ______________________________________________________________________________________ _______________________________________________________________________________________________ BLOS009036-01-2021 CBR2021-1746 6/16/21 $29,600 □ □ □ □ □ □ □ ( City of Carlsbad B-1 Page 2 of 2 Rev. 06/18 ( OPTION A ): WORKERS’COMPENSATION DECLARATION: I hearby affirm under penalty of perjury one of the following declarations:  I have and will maintain a certificate of consent to self-insure for workers’ compensation provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued.  I have and will maintain worker’s compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers’ compensation insurance carrier and policy number are: Insurance Company Name: _______________________________________________ Policy No. _______________________________ Expiration Date: _______________________  Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to be come subject to the workers’ compensation Laws of California. WARNING: Failure to secure workers compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to $100,000.00, in addition the to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney’s fees. ( OPTION B ): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from Contractor’s License Law for the following reason:  I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor’s License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale).  I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor’s License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor’s License Law).  I am exempt under Section __________________Business and Professions Code for this reason:1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. YES NO 2. I (have / have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors’ license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone /contractors’ license number): 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work): 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov CONTRACTOR SIGNATURE: _____________________________________________ X AGENT DATE: _______________ OWNER SIGNATURE: ______________________________________________ AGENT DATE: _______________ CONSTRUCTION LENDING AGENCY, IF ANY: I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender’s Name: ___________________________________________________ Lender’s Address: ___________________________________________________ ONLY COMPLETE THE FOLLOWING SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act?  Yes  No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?  Yes  No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?  Yes  No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. APPLICANT CERTIFICATION: I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.OSHA: An OSHA permit is required for excavations over 5’0’ deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 365 days (AB2913). APPLICANT SIGNATURE: __________________________________________________ DATE: ____________________ ~ /Jad-+ □ □ Building Permit Inspection History Finaled PERMIT INSPECTION HISTORY for (CBR2021-1746) BLDG-Residential 06/16/2021Application Date:Permit Type:Owner:COOWNERS MATTHEW AND YASMINE SCOTT PoolWork Class:Issue Date:Subdivision:LA COSTA MEADOWS #4 Expiration Date:Status: IVR Number: 33997 Closed - Finaled 2728 CAZADERO DR CARLSBAD, CA 92009-5813 Address: Scheduled Date Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection InspectionActual Start Date 09/22/2021 09/22/2021 BLDG-51 Excav/Steel(Pools) 166935-2021 Partial Pass Tony Alvarado Reinspection Incomplete COMMENTS PassedChecklist Item BLDG-Building Deficiency September 22, 2021: 1. Swimming pool and spa reinforcement steel rebar, per swimming pool engineer’s Todd Locker, scope of work per plan – approved. 2. (Partial) – underground plumbing under water leak pressure test and underground electrical conduit for swimming pool and spa area – partial approval. 3. OK to cover trenches with soil, for completed Underground Plumbing lines and Underground Electrical conduit sections – (only). 4. Partial pass – equipotential swimming pool and spa copper bond wire located at four points, swimming pool and spa perimeter –(partial approval). Yes BLDG-52 Pool Plumbing 166934-2021 Partial Pass Tony Alvarado Reinspection Incomplete COMMENTS PassedChecklist Item BLDG-Building Deficiency September 22, 2021: 1. Swimming pool and spa reinforcement steel rebar, per swimming pool engineer’s Todd Locker, scope of work per plan – approved. 2. (Partial) – underground plumbing under water leak pressure test and underground electrical conduit for swimming pool and spa area – partial approval. 3. OK to cover trenches with soil, for completed Underground Plumbing lines and Underground Electrical conduit sections – (only). 4. Partial pass – equipotential swimming pool and spa copper bond wire located at four points, swimming pool and spa perimeter –(partial approval). Yes BLDG-54 Equipotential Bond(Pools) 167107-2021 Partial Pass Tony Alvarado Reinspection Incomplete Friday, January 21, 2022 Page 1 of 5 {cityof Carlsbad PERMIT INSPECTION HISTORY for (CBR2021-1746) BLDG-Residential 06/16/2021Application Date:Permit Type:Owner:COOWNERS MATTHEW AND YASMINE SCOTT PoolWork Class:Issue Date:Subdivision:LA COSTA MEADOWS #4 Expiration Date:Status: IVR Number: 33997 Closed - Finaled 2728 CAZADERO DR CARLSBAD, CA 92009-5813 Address: Scheduled Date Inspection Type Inspection No.Inspection Status Primary Inspector Reinspection InspectionActual Start Date COMMENTS PassedChecklist Item BLDG-Building Deficiency September 22, 2021: 1. Swimming pool and spa reinforcement steel rebar, per swimming pool engineer’s Todd Locker, scope of work per plan – approved. 2. (Partial) – underground plumbing under water leak pressure test and underground electrical conduit for swimming pool and spa area – partial approval. 3. OK to cover trenches with soil, for completed Underground Plumbing lines and Underground Electrical conduit sections – (only). 4. Partial pass – equipotential swimming pool and spa copper bond wire located at four points, swimming pool and spa perimeter –(partial approval). Yes 10/15/2021 10/15/2021 BLDG-23 Gas/Test/Repairs 168732-2021 Passed Tony Alvarado Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency October 15, 2021: 1. underground plumbing under water leak pressure test-approved. 3. underground electrical conduit trench depth protection, for swimming pool and spa area – approved. a) OK to cover trenches with soil, for completed Underground Plumbing lines and Underground Electrical conduit sections – (approved). 4. Partial pass – equipotential swimming pool and spa copper bond wire tails located at four points, swimming pool and spa perimeter –(partial approval). 5. Underground poly propylene-yellow continuous gas line, with trace wire, air pressure leak test, scope of work-approved. Yes BLDG-51 Excav/Steel(Pools) 168668-2021 Passed Tony Alvarado Complete Friday, January 21, 2022 Page 2 of 5 PERMIT INSPECTION HISTORY for (CBR2021-1746) BLDG-Residential 06/16/2021Application Date:Permit Type:Owner:COOWNERS MATTHEW AND YASMINE SCOTT PoolWork Class:Issue Date:Subdivision:LA COSTA MEADOWS #4 Expiration Date:Status: IVR Number: 33997 Closed - Finaled 2728 CAZADERO DR CARLSBAD, CA 92009-5813 Address: Scheduled Date Inspection Type Inspection No.Inspection Status Primary Inspector Reinspection InspectionActual Start Date COMMENTS PassedChecklist Item BLDG-Building Deficiency October 15, 2021: 1. Swimming pool and spa reinforcement steel rebar, per swimming pool engineer’s Todd Locker, scope of work per plan – approved on September 22, 2021: October 15, 2021: 1. underground plumbing under water leak pressure test-approved. 3. underground electrical conduit trench depth protection, for swimming pool and spa area – approved. a) OK to cover trenches with soil, for completed Underground Plumbing lines and Underground Electrical conduit sections – (approved). 4. Partial pass – equipotential swimming pool and spa copper bond wire tails located at four points, swimming pool and spa perimeter –(partial approval). 5. Underground poly propylene-yellow continuous gas line, with trace wire, air pressure leak test, scope of work-approved. Yes BLDG-Building Deficiency September 22, 2021: 1. Swimming pool and spa reinforcement steel rebar, per swimming pool engineer’s Todd Locker, scope of work per plan – approved. 2. (Partial) – underground plumbing under water leak pressure test and underground electrical conduit for swimming pool and spa area – partial approval. 3. OK to cover trenches with soil, for completed Underground Plumbing lines and Underground Electrical conduit sections – (only). 4. Partial pass – equipotential swimming pool and spa copper bond wire located at four points, swimming pool and spa perimeter –(partial approval). Yes BLDG-52 Pool Plumbing 168667-2021 Passed Tony Alvarado Complete Friday, January 21, 2022 Page 3 of 5 PERMIT INSPECTION HISTORY for (CBR2021-1746) BLDG-Residential 06/16/2021Application Date:Permit Type:Owner:COOWNERS MATTHEW AND YASMINE SCOTT PoolWork Class:Issue Date:Subdivision:LA COSTA MEADOWS #4 Expiration Date:Status: IVR Number: 33997 Closed - Finaled 2728 CAZADERO DR CARLSBAD, CA 92009-5813 Address: Scheduled Date Inspection Type Inspection No.Inspection Status Primary Inspector Reinspection InspectionActual Start Date COMMENTS PassedChecklist Item BLDG-Building Deficiency September 22, 2021: 1. Swimming pool and spa reinforcement steel rebar, per swimming pool engineer’s Todd Locker, scope of work per plan – approved. 2. (Partial) – underground plumbing under water leak pressure test and underground electrical conduit for swimming pool and spa area – partial approval. 3. OK to cover trenches with soil, for completed Underground Plumbing lines and Underground Electrical conduit sections – (only). 4. Partial pass – equipotential swimming pool and spa copper bond wire located at four points, swimming pool and spa perimeter –(partial approval). Yes BLDG-Building Deficiency October 15, 2021: 1. underground plumbing under water leak pressure test-approved. 3. underground electrical conduit trench depth protection, for swimming pool and spa area – approved. a) OK to cover trenches with soil, for completed Underground Plumbing lines and Underground Electrical conduit sections – (approved). 4. Partial pass – equipotential swimming pool and spa copper bond wire tails located at four points, swimming pool and spa perimeter –(partial approval). 5. Underground poly propylene-yellow continuous gas line, with trace wire, air pressure leak test, scope of work-approved. Yes 10/22/2021 10/22/2021 BLDG-54 Equipotential Bond(Pools) 169125-2021 Passed Tony Alvarado Complete Friday, January 21, 2022 Page 4 of 5 PERMIT INSPECTION HISTORY for (CBR2021-1746) BLDG-Residential 06/16/2021Application Date:Permit Type:Owner:COOWNERS MATTHEW AND YASMINE SCOTT PoolWork Class:Issue Date:Subdivision:LA COSTA MEADOWS #4 Expiration Date:Status: IVR Number: 33997 Closed - Finaled 2728 CAZADERO DR CARLSBAD, CA 92009-5813 Address: Scheduled Date Inspection Type Inspection No.Inspection Status Primary Inspector Reinspection InspectionActual Start Date COMMENTS PassedChecklist Item BLDG-Building Deficiency October 22, 2021: 1. Equipotential pool bond ground wire bonded at deck steel reinforcement rebar, located at 4-points at pool perimeter-pass. Yes BLDG-Building Deficiency September 22, 2021: 1. Swimming pool and spa reinforcement steel rebar, per swimming pool engineer’s Todd Locker, scope of work per plan – approved. 2. (Partial) – underground plumbing under water leak pressure test and underground electrical conduit for swimming pool and spa area – partial approval. 3. OK to cover trenches with soil, for completed Underground Plumbing lines and Underground Electrical conduit sections – (only). 4. Partial pass – equipotential swimming pool and spa copper bond wire located at four points, swimming pool and spa perimeter –(partial approval). Yes 11/24/2021 11/24/2021 BLDG-55 Fence/Preplaster 171349-2021 Passed Tony Alvarado Complete COMMENTS PassedChecklist Item BLDG-Building Deficiency November 23, 2021: 1. Perimeter swimming pool/spa protective safety barrier, UL listed product and additional floatable listed water alarm device-approved. Yes 01/21/2022 01/21/2022 BLDG-Final Inspection 175004-2022 Passed Tony Alvarado Complete COMMENTS PassedChecklist Item BLDG-Plumbing Final Yes BLDG-Mechanical Final Yes BLDG-Structural Final Yes BLDG-Electrical Final Yes Friday, January 21, 2022 Page 5 of 5 STORM WATER POLLUTION PREVENTION NOTES 1.ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BEAVAILABLE ON SITE TO FACILITATE RAPID INSTALLATIONOF EROSION AND SEDIMENT CONTROL BMPs WHEN RAINIS EMINENT. 2.THE OWNER/CONTRACTOR SHALL RESTORE ALL EROSIONCONTROL DEVICES TO WORKING ORDER TO THE SATISFACTIONOF THE CITY INSPECTOR AFTER EACH RUN-OFF PRODUCINGRAINFALL. 3.THE OWNER/CONTRACTOR SHALL INSTALL ADDITIONAL EROSIONCONTROL MEASURES AS MAY BE REQUIRED BY THE CITYINSPECTOR DUE TO INCOMPLETE GRADING OPERATIONS ORUNFORESEEN CIRCUMSTANCES WHICH MAY ARISE. 4.ALL REMOVABLE PROTECTIVE DEVICES SHALL BE IN PLACEAT THE END OF EACH WORKING DAY WHEN THE FIVE (5)DAY RAIN PROBABILITY FORECAST EXCEEDS FORTY PECENT( 40%). SILT AND OTHER DEBRIS SHALL BE REMOVED AFTEREACH RAINFALL. 5.ALL GRAVEL BAGS SHALL CONTAIN 3/4 INCH MINIMUMAGGREGATE. 6.ADEQUATE EROSION AND SEDIMENT CONTROL AND PERIMETERPROTECTION BEST MANAGEMENT PRACTICE MEASURES MUSTBE INSTALLED AND MAINTAINED. 7.THE CITY INSPECTOR SHALL HAVE THE AUTHORITY TO ALTERTHIS PLAN DURING OR BEFORE CONSTRUCTION AS NEEDEDTO ENSURE COMPLIANCE WITH CITY STORM WATER QUALITYREGULATIONS. OWNER'S CERTIFICATE: I UNDERSTAND AND ACKNOWLEDGE THAT I MUST: (1) IMPLEMENT BEST MANAGEMENT PRACTICES {BMPS) DURING CONSTRUCTION ACTIVITIES TO THE MAXIMUM EXTENT PRACTICABLE TO AVOID THE MOBILIZATION OF POLLUTANTS SUCH AS SEDIMENT AND TO AVOID THE EXPOSURE OF STORM WATER TO CONSTRUCTION RELATED POLLUTANTS; AND (2) ADHERE TO, AND AT ALL TIMES, COMPLY WITH THIS CITY APPROVED TIER 1 CONSTRUCTION SWPPP THROUGHOUT THE DURATION OF THE CONSTRUCTION ACTIVITIES UNTIL THE CONSTRUCTION WORK IS COMPLETE AND APPROVED BY THE CITY OF CARLSBAD. OWNER{S)/OWNER'S AGENT NAME {PRINT) OWNER{S)/OWNER'S AGENT NAME {SIGNATURE) DATE E-29 STORM WATER COMPLIANCE FORM TIER 1 CONSTRUCTION SWPPP BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE Erosion Control Sediment Control BMPs Tracking Non-Storm Water Waste Management and Materials BMPs Control BMPs Management BMPs Pollution Control BMPs C: C: C: 0 ..... ..... 0 0 ::;:; C: C: "'C ::;:; ::;:; C'I C (I) "'C (I) "'C U) C: u u C: C: C'I E C: E C: ..... C ..... ::::, ::::, 0 '5 ·;:: ,Q-C C C E L. L. (I) :::::ii: "'C U) C'I L. (I) ..... .....::;:; L.::::, >, C'I C: '-C'I C: (I) L. C: (I) C: U)U) U) � ·;:: C'" L. C C: Cc a. (I) 'a. ·;:: -C: U) C: L. w !!,! 0 Best Management Practice* ,:a C: C CD L. 0 (I) 0 L.(.!) (I) C: ::;:; ..c: U) 3 U) � (I) C C: (.) L. (.) (I) ..... (I) C ..... C: E U) �"'C cu U) :::::ii: C: (I) C: (BMP) Description � U) u (I) U) ·e U) C'I (I) C'I CD ·a c:C'I C: "'C U) C: !!,! ..... (I) .!! ::i � (I) (I) C C 3 C: '"2� C: C: Cl ::::, u .....0 L. 0 "'C >, 0 U) C (I) �E ::;:; C: Cl CD U) ·-C'I Cl::;:; �c (.) (I) C o C'I (I) :::::ii: Cl C'I Cl C: (I) a::: E C N Ul C):;:; (I) cj<D c ·a. L. -� (I) X (I) u .!! ,!;;; (I) C E �cu ..... ::::, ..0 E� = U) =3 ... ·-::c ·-C'I ·;:: a. 0 C'I "'C ..c: C: (I) LL C: C u C: .._ C � L. u L. > (I)::::, "'C ::.c � ·-"'C �o ·-L. C (I) L. (I) u _ ..... "'C C 0 -+-'•-a.'5 (I) L. ..... ..0 C •-C 0 L. C ..... (I) C (I) u C: 00 i; :g ..... ..... 0 ..... = C: ·- C: 0 0 ..0 _;. C C C'I .s 0 CC ..c: (I) 0 oc (I) C L. (I) ..c: L. C ..... L. Cl) C: 0 �<3 c...., C ..... a. 0 (.!) � WCl vi en U) (.) ti: (.!) Ul> U) U)Q. U)a:::�ct a.a a.:::::ii: U) :::::ii: U) U) (.) U) :::::ii: CASQA Designation � r--00 0) ..... I"') '<t LO CD r--00 0 N I"') r--00 ..... N I"') '<t LO ..... ..... ..... ..... I I I I I I I I I I I I I I I I I I I I I I I (.) (.) (.) (.) w w w w w w w w � � U) U) U) U) :::::ii: :::::ii: :::::ii: :::::ii: :::::ii: Construction Activity w w w w U) U) U) U) U) U) U) U) z z z z � � � � � Gradina/Soil Disturbance Trench in a /Excavation Stockoilina Drill in a /Borina Concrete/ Asohalt Sawcuttinq Concrete Flatwork Pavina Conduit/Pioe Installation Stucco/Mortar Work Waste Disoosal Staaina/Lav Down Area Eauioment Maintenance and Fuelinq Hazardous Substance Use/Storaqe Dewaterinq Site Access Across Dirt Other (list): Instructions: 1.Check the box to the left of all applicable construction activity {first column) expected to occur during construction. 2.Located along the top of the BMP Table is a list of BMP's with it's corresponding California Stormwater Quality Association {CASQA) designation number. Choose oneor more BMPs you intend to use during construction from the list. Check the box where the chosen activity row intersects with the BMP column. 3.Refer to the CASQA construction handbook for information and details of the chosen BMPs and how to apply them to the project. PROJECT INFORMATION Site Address: ______________ _ Assessor's Parcel Number: ---------- Emergency Contact: Name: ________________ _ 24 Hour Phone: __________ _ Construction Threat to Storm Water Quality {Check Box) 0 MEDIUM O LOW (I) ..... U) C � .....C: U) (I) :::::i E0 (I) � C'I cc N C: cc :::C::::::i: CD I :::::ii: � (I) ..... U) C-+-' � C:(I) <DE ..... (I) � C'I uc C: C: QC (.) :::::ii: 00 I :::::ii: � Page 1 of 1 REV 11/17 ____________-____________ DAVID JONES 2727 CAZADERO DRIVE 215-400-05-00 MARTY MEAD (760) 586-7222 6/3/2021 X X X X X X X X X X X X ✓ X X X X